Atypical Presentation of Lyme Neuroborreliosis

A 66-year-old woman presented with asymmetric rigidity predominantly on the left side and memory loss (initial Mini-Mental State Examination [MMSE] score 15/30). No tick bite was reported. CSF analysis revealed hyperproteinorachia and leukocytosis with Lyme borreliosis intrathecal antibody production. A cerebral MRI demonstrated diffuse supra- and infratentorial white matter lesions sparing red nuclei and substantia nigra (Figure 1, A and B)....